Acute tetrodotoxin-induced neurotoxicity after ingestion of puffer fish

Ann Neurol. 2005 Mar;57(3):339-48. doi: 10.1002/ana.20395.


This study documents the effects of puffer-fish poisoning on peripheral nerve. Excitability measurements investigated membrane properties of sensory and motor axons in four patients. The median nerve was stimulated at the wrist, with compound muscle potentials recorded from abductor pollicis brevis and compound sensory potentials from digit 2. Stimulus-responses, strength-duration time constant (tau(SD)), threshold electrotonus, and current-threshold relations were recorded. The urine of each patient tested positive for tetrodotoxin. Compared with controls, axons were of higher threshold, compound muscle action potentials and compound sensory nerve action potentials were reduced in amplitude, latency was prolonged, and tau(SD) was reduced. In recovery cycles, refractoriness, superexcitability, and late subexcitability were decreased. Threshold electrotonus of motor axons exhibited distinctive abnormalities with less threshold decline than normal on depolarization and greater threshold increase on hyperpolarization (p < 0.0005 for each patient). The changes in excitability were reproduced in a mathematical model by reducing sodium (Na(+)) permeabilities by a factor of two. This study confirms that the neurotoxic effects of puffer-fish poisoning can be explained by tetrodotoxin blockade of Na(+) channels. It demonstrates the ability of noninvasive nerve excitability studies to detect Na(+) channel blockade in vivo and also the utility of mathematical modeling to aid interpretation of altered excitability properties in disease.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Action Potentials / drug effects
  • Action Potentials / radiation effects
  • Adult
  • Animals
  • Female
  • Foodborne Diseases / etiology*
  • Foodborne Diseases / urine
  • Humans
  • Male
  • Membrane Potentials / drug effects
  • Middle Aged
  • Models, Neurological
  • Muscle, Skeletal / drug effects
  • Muscle, Skeletal / radiation effects
  • Neural Conduction / drug effects
  • Neurotoxicity Syndromes / etiology*
  • Neurotoxicity Syndromes / urine
  • Reaction Time / drug effects
  • Reaction Time / radiation effects
  • Sensory Thresholds / drug effects
  • Sensory Thresholds / radiation effects
  • Sodium / metabolism
  • Sodium Channel Blockers / poisoning*
  • Sodium Channel Blockers / urine
  • Sodium Channels / drug effects
  • Tetraodontiformes*
  • Tetrodotoxin / poisoning*
  • Tetrodotoxin / urine
  • Time Factors


  • Sodium Channel Blockers
  • Sodium Channels
  • Tetrodotoxin
  • Sodium